A lot of questions pop up when you’ve made the decision to go abroad. That is the first big step. Once it’s taken, the road to success will slowly materialise. The two most common paths like PLAB and USMLE will be discussed in this article. Instead of making it a comparison like PLAB vs USMLE, this will be more of a discussion than a comparison, as my purpose is neither to discourage or encourage you in any specific path. The information will be laid out in front of you, but at the end of the day- you’re the master of your fate, you’re the captain of your soul.
To have an overall idea about post-graduation options UK and also in the USA, Bangladesh, India, and Pakistan, please have a look at this post- Postgraduation Pathways in the UK and Postgraduation at home & abroad.
Table of Contents
PLAB
The full form of PLAB is Professional Linguistic and Assessments Board.
It is a licensing examination to assess whether a doctor is eligible to obtain GMC Registration or not. It’s NOT a degree, or a certification by itself. It only makes you eligible to apply for GMC registration.
Why do I need GMC registration?
In the UK, to practice as a doctor, GMC registration is a MUST. Life as doctor in the UK pretty much revolves around the General Medical Council (GMC). They maintain their register of medical practitioners, general practitioners, and specialists. In order to practice at that level, you need to be registered with GMC. To make things clear, GMC will NOT provide you with any degree. That’s the job of the Royal Colleges’ and other training bodies’ function. But, GMC will just recognize your degree.
When in my career can I take the PLAB exam?
The earlier, the better. But it may not be possible for everyone. That being said, you can take PLAB anytime in your career, so long as you have received your primary medical qualification.
PLAB Exam Structure
The exam has two parts-
- PLAB 1
- PLAB 2
PLAB 1 is an MCQ exam
PLAB 1 is a 3 hour 180 MCQ (single best answer) exam which can be taken right after you obtain your primary medical qualification. It can be taken in many places around the world. They run March and November exams all over the world and also in the UK, where they have two extra exam dates usually in June and September.
But IELTS/OET is a pre-requisite. You will have to obtain 7.5 overall (with 7.0 in each module) in IELTS and “B” in OET to be able to sit for PLAB 1. To see how you can plan your IELTS and PLAB 1, please look here. Also you can use Occupational English Test (OET) to prove your english language proficiency. You will need grade B in all the sub-tests of the OET. Read further here.
PLAB 2 is an OSCE exam
PLAB 2, on the other hand, is a practical assessment and takes the form of an Objective Structured Clinical Examination (OSCE). Usually there are 18 stations spanning 8 minutes each, excluding at least 2 rest stations. It happens year round and ONLY takes place in Manchester, UK.
The only requirement to sit for PLAB 2 is passing PLAB 1. Also, you will have to take PLAB 2 within 2 years of passing PLAB 1. You DO NOT need to have a valid IELTS/OET to take PLAB 2.
PLAB Exam Fees and other associated costs
| IELTS | (Academic) | ~£175 |
| OET | (Medicine) | ~£338 |
| PLAB 1 | (UK or abroad) | £247 |
| PLAB 2 | (UK only) | £906 |
| GMC Registration | PROVISIONAL registration | £53 |
| FULL registration | £161 (fresh grad)/ £420 (>5 years since graduation) | |
| TOTAL COST | Provisional Registration pathway | £1,381 – £1,544 |
| Full Registration pathway | £1,489 – £1,911 |
Please read how to plan funding for your PLAB journey for detailed breakdown of all the associated costs.
Where will I stand after passing PLAB?
PLAB will get you registered with GMC. Whether that registration will be provisional or full is dependent on your completion of an acceptable pattern of internship. If you’ve not completed an acceptable pattern, you will obtain provisional registration, and will need to apply for the UK foundation program (UKFP) or complete an acceptable pattern elsewhere and then update your registration.
UKFP is a rotational training post which lasts two years, and it is paid. It does not matter if you are an international doctor- you can apply for it just the same as a UK national/graduate. If you have full registration, but would still like to start from an internship-ish level, you can consider applying for the FY2 standalone program. These are also training posts at an FY2 level, which occur due to gaps in the foundation program.
If you are eligible and have full GMC registration, you can look to apply for core or specialty training. Mostly what you’ll require is a solid portfolio and a valid CREST form. Please keep in mind that you do not have to undergo foundation training in the UK if you have an acceptable pattern of internship. It is completely possible to directly start in a training program/residency if you meet the criteria.
If you have several years of experience back home, and have completed a relevant post-graduate exam as well, you can even look to apply for a higher specialty training/fellowship/registrar post if you have the competencies required to do so. So it is completely possible in the UK to ‘skip’ certain parts of the training progression pathway, depending on your experience.
Now, if you have full GMC registration, but either are not eligible for a training program, or just that you wish to first get a little NHS experience before you apply, you can look into applying for a non-training job. While not a concept in the USA (where you can only practice after you have been successful in the Match), non-training jobs can be found at their training equivalent levels and pay scales, but with a different application process and career progression. If you wish, you can continue your UK career in just non-training jobs, or you can move onto a training job after spending some time in a non-training post.
What you score is in PLAB DOES NOT matter at all anywhere in you application process, be it for UKFP, FY2 standalone, core/specialty training, or a non-training job.
Planning your PLAB journey
USMLE
USMLE stand for United States Medical Licensing Examination
What is the USMLE
The USMLE is an exam that must be taken by American medical graduates and IMGs alike. After ensuring your ECFMG registration is done, Steps 1 and 2A may be taken. Step 3 can be taken in between getting your ECFMG certification and applying for the Match, or even after you get a Match. American graduates typically take it at the end of their first year of residency.
To learn more about the structure of training/residency in the American healthcare system, please read the post on Postgraduation pathways at home and abroad.
Why do you need to take the USMLE?
It is the set of examinations needed for medical licensure in the United States. Physicians are required to pass this examination before being permitted to practice medicine in the United States. It will not give you any sort of a degree.
When can I take it?
As an IMG, you may take it at any time during your career, even during medical school. You don’t need to complete any sort of internship or get clinical experience in order to take the exams. Observer-ships, externships, sub-internships may be considered to bolster your CV, but are not prerequisites for the USMLE.
USMLE Exam Structure
STEP 1 consists of an 8 hour exam that is divided into 7 blocks, each of which are 60 minutes long. The exam tends to consist of around 280 questions, roughly 40 per block.
STEP 2A (or the CK/Clinical knowledge exam) is a 9 hour exam that is further divided into 8 blocks that are each 60 minutes long. Each block will not exceed 40 questions.
STEP 3 is the final part. The exam is a two day event, with the first day consisting of 233 questions divided into 6 blocks. You are given 60 minutes per block, and including a break, the entire exam will take about 7 hours.
On the second day, you will face a 9 hour exam of 180 questions divided into 6 blocks. After that, you will have to undergo 13 case simulations where you’ll be allotted 10 or 20 minutes to complete.
Where can I take USMLE?
STEPs 1 and 2A can be taken in most overseas centers and the United States, but STEP 3 can only be taken within the United States.
USMLE Exam Fees
| ECFMG certification | $160 |
| STEP 1 | $985 |
| STEP 2A/CK | $985 |
| STEP 3 | $895 |
| OET | $455 |
| Application to a Pathway for ECFMG Certification (2023 Match) | $925 |
Now this isn’t as cut and dry as it may seem. If you intend on attending the STEP 1 and 2A back home, there are added fees you must incorporate.
Not only that, but if you wish to change your eligibility period, reschedule, change your testing region, or any other support related to your exam/application, you can expect an additional cost every step of the way.
Just taking into account the fees listed in the chart above, you can expect all parts of the USMLE to set you back a cool $3,950 (~£3,163), excluding all expenses related to travel, living, and study materials.
Where do I stand after USMLE?
After completing all the requirements and formalities needed for the STEPs in USMLE, you can now apply for residency. Congrats! The Match is the name given to the program used to allot residents to their intended paths of training. It provides a uniform process in that all the steps of the process are completed in the same fashion and at the same time by all applicants and participating institutions. So, having passed all the steps doesn’t confirm your residency, you will still have to apply and MATCH!
Remember as we outlined above, without a successful Match, you cannot work as a doctor in the USA. It is also not possible to ‘skip’ any part of the residency/fellowship program as outlined above for the UK.
While Step 1 has now been made pass/fail, your scores from the other exams are still important in the selection process, unlike in the UK.
To understand how the Match algorithm works, please look here. To understand when it takes place, and to further understand the system, read more here.
You can apply for up to 20 programs at a cost of $85. If you wish to apply for more, there will be another cost of $30 per program, with a maximum of 300 programs. The full breakdown can be found here.
PLAB vs USMLE
The comparison made below between PLAB and USMLE is mainly focused on the nature of the exam. There are so many other factors to consider apart from these. So, I urge you not to just decide on one path simply because the next person is doing it.
At the end of the day, job satisfaction and having a good quality of life should be given priority even though it may seem too early to think about.
So there you have it! A somewhat concise discussion regarding the two major exams most IMGs choose to go for after completing their degree. Just remember that at the end of the day, the choice is yours to make.
Good luck!
